Presentation on theme: "Shock Remember Perfusion …."— Presentation transcript:
1 Shock Remember Perfusion …. Shock is inadequate perfusion (aka Hypoperfusion)The organs and tissues of the body do not get enough oxygen and nutrients.
2 ShockIt can occur with either traumatic injuries or serious medical conditions
3 What causes Shock?Shock is the result of a malfunction of at least 1 of 3 systemsPump (Heart)Tubing (Blood Vessels)Fluid (Blood)The cardiovascular system is made up of three key elements: a Pump (heart), Tubing (vessels) and Blood (vehicle for carrying O2/nutrients and ridding waste products).Blood moves as a result of a pressure gradient generated with each heart contraction and is affected by dilating and constricting blood vessels. Pressure is controlled by the body so there is always sufficient circulation or perfusion in the various tissues and organs.(colors have significance)
4 What are the types of shock? Remember MASHNCPRMetabolicExcessive loss of fluid & electrolytes with non-hemorrhagic cause1. GI: vomiting/diarrhea/ urination,2. burns3. drugs4. hyperglycemia5. heat strokeAnaphylacticSystemic allergic reaction causing widespread vasodilation and generalized edema ; has an upper respiratory component1. insect sting or bite2. ingestion (eg legumes),3. Rx (eg penicillin PCN)4. inhalants (pollen, dust)SepticSystemic infection, usually bacterial, damages vessel walls resulting in leakage and vasodilation;1. untreated wound,2. surgery,3. trauma (peritonitis);4. disease (pericarditis), or5. contagion (meningitis,pneumonia)
5 Hypovolemic Neurogenic Cardiogenic Loss of fluid volume (blood) with hemorrhagic cause (eg trauma); could be external or internalBleeding due to1. Blunt trauma to solid abdominal organ,2. great vessel tear,3. major bleed from laceration or fxNeurogenicSudden loss of the control by CNS of nerves & muscles, causing vasodilation & muscle paralysis1. brain => Increased Intercranial pressure due to trauma, tumor, bleeding2. spinal cord => due to fx, vertebral bleeding, or tumorCardiogenicHeart muscle can no longer generate enough pressure to circulate blood to all organs; leads to pulmonary edema1. Myocardial Infarction2. Disease (CHF, pericarditis),3. Electrical,4. Trauma (Pericardial tamponade)5. Valve dysfunction,Psychogenicfainting resulting from temporary vascular dilation (loss of blood pressure) and lack of blood to brainShock to senses, strong emotional response, or psychotic crisisRespiratory InsufficiencyInability to oxygenate the blood at level required1. Disease (Asthma, COPD)2. Trauma (pneumothorax, flail chest)3. obstruction
6 Progression of Shock: Compensated Shock When the body’s systems work to maintain perfusion by going into “overdrive”
7 Progression of Shock: What do you see Compensated Shock –Brain = anxiety, restlessness, ALOCHeart = weak rapid pulse, OK to BPRespiration = rapid, shallow TV, noiseSkin Sx = pale, cool, clammyCap Refill = > 2 secsOther: nausea or vomiting; decrease in body temp
8 Progression of Shock: Decompensated Shock Body’s efforts to maintain perfusion fail.Children can compensate longer than adults, but crash quicklyFalling BP is the key sign.
9 Progression of Shock: What do you see Decompensated ShockBrain = ALOC -> unconsciousnessHeart = thready or irr or absent, BPRespiration = laboredSkin Sx = ashen, cyanotic, diaphoreticCap Refill = > 2 secsOther: nausea or vomiting; decrease in body temp; dull eyes; dilated pupils
10 What can you do? --- BSI, ABCs - Open airway, Control Bleeding- Provide high flow O2; assist respirationsPlace patient supine with legs elevated 6” to 12” above heart; If spinal injury elevate backboardMay use other position of comfort for heart patient, breathing distress, etcKeep patient warm (easy hypothermia)
11 What can you do? --- Emergency evacuation Record vitals every 5 minutesSplint bone or joint injuriesGive nothing by mouth; have suction readyEmergency evacuation
12 Anticipate Shock!!Plan AheadAlways anticipate shock when a suitable mechanism of injury or illness existsEarly anticipation and care can prevent or delay decompensated shock
13 Transport Head up or down? Normally, for shock, head down (want feet elevated)BUT, what if head injury and signs of shock? Judgment call – head (brain swelling) would be priority
14 Anaphylactic Shock – What can you do? --- The only truly effective treatment is EPINEPHRINE (opens airway) followed by ANTIHISTAMINE (reduces bronchial swelling)Many people with known serious allergic reactions carry epipens